Urethral monopolar cauterization: alternative infravesical obstruction model in male rats.

OBJECTIVE: We aimed to determine which method gives the most consistent results between urethral monopolar cauterization and standard urethral partial ligation methods for the urethral obstruction model. METHODS: Thirty male rats were randomly divided into control, partial ligation, and monopolar cauterization groups. Six weeks after experimental procedures, the experimental groups were evaluated cystometrically, biochemically, and histologically. RESULTS: According to the cystometric results, bladder capacity, baseline bladder pressure, and compliance data of the monopolar cauterization group were higher than those of the partial ligation and monopolar cauterization groups (p<0.05 and p<0.01, respectively). As a biochemical evaluation, malondialdehyde levels in bladder tissues of group control were higher than partial ligation and monopolar cauterization groups (p<0.05 and p<0.01, respectively). The collagen type I level of the control group was higher than the partial ligation and monopolar cauterization groups (p<0.01 and p<0.05, respectively). Collagen type III levels of the monopolar cauterization group were higher than those of the control group (p<0.01), but the Collagen type I/Collagen type III and transforming growth factor-ß levels of the monopolar cauterization group were significantly lower than those of the control group (p<0.001). As a histological evaluation (hematoxylin and eosin), fibrosis in the lamina propria was more prominent in the monopolar cauterization group than in the control group (p<0.05). In addition, the muscular thickness was higher in the monopolar cauterization group compared with control and partial ligation groups (p<0.001 and p<0.01, respectively). CONCLUSION: The needle-tipped monopolar cauterization of the posterior urethra may be the method of choice for creating a chronic infravesical obstruction model of infravesical obstruction in male rats.

Protective effect of platelet-rich plasma on urethral injury model of male rats.

AIMS: Urethral stricture (US) formation is caused by fibrosis after excessive collagen formation following an injury or trauma to the urethra. In this study, we aimed to evaluate the effects of platelet-rich plasma (PRP) on a urethral injury (UI) model of male rats. METHODS: A UI model was used by applying a coagulation current to the urethras of male rats. There were four groups with six rats in each: control group, PRP applied to naive urethra, UI group, and UI with PRP application. PRP was applied to the urethra after a coagulation current-induced injury as soon as possible. On the 14th day, all rats were sacrificed and urethral tissues were investigated for collagen type I, collagen type III, platelet-derived growth factor-α, platelet-derived growth factor-ß, and transforming growth factor-ß using quantitative real-time polymerase chain reaction and Western blot analysis. The effect of urethral damage and healing was evaluated for collagen type I-to-collagen type III ratio. RESULTS: The collagen type I-to-collagen type III ratio was significantly higher in UI group (P < 0.05) than in the others, while UI with PRP application group had comparable results with the control group (P > 0.05). CONCLUSIONS: The results of this study show that PRP has a preventive effect on stricture formation in a UI model of rats, as shown by its effect on collagen synthesis. Further studies that eventually show the effects of PRP on human tissues are necessary and promising.

The efficacy and utilisation of preoperative multiparametric magnetic resonance imaging in robot-assisted radical prostatectomy: does it change the surgical dissection plan?

OBJECTIVE: We investigated the effect of the use of multiparametric prostate magnetic resonance imaging (mp-MRI) on the dissection plan of the neurovascular bundle and the oncological results of our patients who underwent robot-assisted radical prostatectomy. MATERIAL AND METHODS: We prospectively evaluated 60 consecutive patients, including 30 patients who had (Group 1), and 30 patients who had not (Group 2) mp-MRI before robot-assisted radical prostatectomy. Based on the findings of mp-MRI, the dissection plan was changed as intrafascial, interfascial, and extrafascial in the mp-MRI group. Two groups were compared in terms of age, prostate-specific antigen (PSA), Gleason sum scores and surgical margin positivity. RESULTS: There was no statistically significant difference between the two groups in terms of age, PSA, biopsy Gleason score, final pathological Gleason score and surgical margin positivity. mp-MRI changed the initial surgical plan in 18 of 30 patients (60%) in Group 1. In seventeen of these patients (56%) surgical plan was changed from non-nerve sparing to interfascial nerve sparing plan. In one patient dissection plan was changed to non-nerve sparing technique which had extraprostatic extension on final pathology. Surgical margin positivity was similar in Groups 1, and 2 (16% and 13%, respectively) although, Group 1 had higher number of high- risk patients. mp-MRI confirmed the primary tumour localisation in the final pathology in 27 of of 30 patients (90%). CONCLUSION: Preoperative mp-MRI effected the decision to perform a nerve-sparing technique in 56% of the patients in our study; moreover, changing the dissection plan from non-nerve-sparing technique to a nerve sparing technique did not increase the rate of surgical margin positivity.

Color Doppler ultrasound characteristics after subinguinal microscopic varicocelectomy.

AIM: The present study evaluated the effect of differences in the peak systolic velocity (PSV) and resistive index (RI) in the testicular artery (TA), capsular artery (CA), and intratesticular artery (ITA) after microscopic subinguinal varicocelectomy (MSV) on postoperative pain and semen parameters. PATIENTS AND METHODS: Scrotal color Doppler ultrasound (CDUS) measurements were made in 33 patients (age 18-31 years) prior to MSV and 3 and 6 months after MSV. Pain was recorded using a visual analog scale and sperm concentration was determined to analyze the predictive value of the CDUS parameters regarding surgical outcome. RESULTS: A significant decrease in pain scores was observed in most patients at both follow-ups. The first postoperative CDUS revealed a significant increase in the TA-PSV (p<0.001) and a decrease in the TA-RI (p=0.002) and CARI (p=0.006). The second postoperative CDUS also revealed a significant increase in the TA-PSV and a decrease in the TA-RI, and the PSV in the ITA and CA and RI in the ITA and CA were significantly different from the values obtained pre-operatively and at the first follow-up. A negative correlation was found between the pain level and TA-PSV (r=-0.433, p=0.012), whereas sperm concentration positively correlated with both the TA-PSV and CA-PSV (r=0.534, p=0.001 and r=0.455, p=0.008, respectively). CONCLUSIONS: The PSV and RI are useful parameters for detecting changes in testicular microhemodynamics after MSV. In addition, the TA-PSV and CA-PSV can be used to predict improvements in pain and sperm concentration.

The Association between Urinary Incontinence and Low Back Pain and Radiculopathy in Women.

AIM: Urinary incontinence (UI) is a common dysfunction, affecting especially women of all ages. The terminology of low back pain (LBP) and radiculopathy (RP) may be misused interchangeably with each other. There are many reports of the association with LBP and incontinence but those involving compression of nerve root(as RP), has not been distinguished from isolated low back pain. This study was structured to analyse the association of UI, LBP and RP. METHODS: One hundred twenty patients were included in the study. Patients with spinal or urinary infection, tumour (spinal or others), cauda equine, pelvic operation, spinal trauma, spinal surgery, urogenital pathology were not accepted for this study. Age and weight of all patients were determined. Oswestry Disability Index (ODI) was utilised for assessment of loss of function and SEAPI incontinence index was used for urinary incontinence. All patients were examined for neurological pathology to differentiate between the LBP and RP by department of neurosurgery. Student t-test and Mann-Whitney-U tests were used for statistical significance. RESULTS: There was no statistical significance between low back pain with overall urinary incontinence (p = 0.131), urge (p = 0.103) or stress incontinence (p = 0.68), respectively. However; The statistical aspects were identified relationship between overall (p = 0.026) and urge (p = 0.001) urinary incontinence with radiculopathy. The association of urge incontinence and radiculopathy seems to show a more significant relationship. Yet there was no correlation between radiculopathy and stress incontinence (P = 0.062). CONCLUSION: Low back pain should not be regarded as a predisposing factor for urinary incontinence; however, radiculopathy has a statistically positive correlation between overall incontinence and urge incontinence.

Intravenous paracetamol for relief of pain during transrectal-ultrasound-guided biopsy of the prostate: A prospective, randomized, double-blind, placebo-controlled study.

Transrectal-ultrasound-guided prostate biopsy (TRUS-PBx) is the standard procedure for diagnosing prostate cancer. The procedure does cause some pain and discomfort; therefore, an adequate analgesia is necessary to ensure patient comfort, which can also facilitate good-quality results. This prospective, randomized, double-blinded, placebo-controlled study aimed to determine if intravenous (IV) paracetamol can reduce the severity of pain associated with TRUS-PBx. The study included 104 patients, scheduled to undergo TRUS-PBx with a suspicion of prostate cancer, that were prospectively randomized to receive either IV paracetamol (paracetamol group) or placebo (placebo group) 30 minutes prior to TRUS-PBx. All patients had 12 standardized biopsy samples taken. Pain was measured using a 10-point visual analog pain scale during probe insertion, during the biopsy procedure, and 1 hour postbiopsy. All biopsies were performed by the same urologist, whereas a different urologist administered the visual analog pain scale. There were not any significant differences in age, prostate-specific antigen level, or prostate volume between the two groups. The pain scores were significantly lower during probe insertion, biopsy procedure, and 1 hour postbiopsy in the paracetamol group than in the placebo group. In conclusion, the IV administration of paracetamol significantly reduced the severity of pain associated with TRUS-PBx.

Effectiveness of pelvic floor muscle training on symptoms and uroflowmetry parameters in female patients with overactive bladder.

BACKGROUND/AIM: To evaluate the effects of pelvic floor muscle training (PFMT) on symptoms of overactive bladder (OAB) as well as uroflowmetry parameters and functional bladder capacity. MATERIALS AND METHODS: Fifty-nine female patients with OAB symptoms were included. Patients were assessed by SEAPI-QMM, uroflowmetry, and abdominal ultrasound. A specially designed PFMT program using a Pilates ball was generated for patients. The training period was 1-h sessions twice a week for 6 weeks and aerobic home exercises to be performed at home 4 or 5 times every other day. Following training, subjects were reevaluated for body mass index, SEAPI questionnaire, and uroflowmetry. RESULTS: Initial mean SEAPI score, mean maximum and average flow rates, and mean voided volume were 9.8 ± 7.2, 29.8 ± 16.4 mL/s, 16.3 ± 8.7 mL/s, and 211.6 ± 173.5 mL, respectively. After completion of the training program, SEAPI scores improved significantly to 3.4 ± 6.4 (P < 0.05). Maximum and average flow rate results did not show significant changes, whereas voided volume seemed to have improved in conjunction with patients' symptom scores (Pearson correlation coefficient: 0.86). CONCLUSION: According to. our results, we think that proper PFMT results in increase of functional bladder capacity as well as improvement in OAB symptoms and can be recommended as first-line therapy or in conjunction with medical therapy in severe cases.

Prostate myths: What is the prostate awareness in the general male population in Turkey?

OBJECTIVE: The aim of the study was to evaluate prostate awareness in the general male population and discover the common misinformation about prostate diseases (PDs). MATERIAL AND METHODS: A cross-sectional population sampling was performed in the general population for men between the ages of 18-70 with a survey conducted by medical students. The survey consisted of 15 questions addressing different aspects of PDs and common misinformation in the general population. All participants were stratified according to age, degree of education, occupation and whether the person himself or a close relative had visited a urologist for PDs. All questionnaires were anonymous, and patients were informed about the confidentiality of the results. RESULTS: A total of 1004 men between the ages of 18-70 were included in the study (mean age 38.0±12.9 years). Of those included, 20.2% were primary school graduates, 8.6% were secondary school graduates, 25.5% were high school graduates, 39.8% were university graduates, and 5.8% had a doctorate or higher education. Of all 1004 men, 31.5% had seen a urologist or attended an interview with a close relative for a PDs-related visit in a urologist's office; 56.2% reported "prostate" as a disease and only 16.5% as an organ. In terms of beliefs, 50.2% believed that all men had a "prostate," 5.4% said that sexual activity would cause PDs, 13% thought that sexual activity would prevent PD, 24.9% reported that a rectal exam would affect sexual activity, and 63.5% believed that urinating when squatting would prevent prostate hyperplasia. Prostate cancer transmission to sexual partners was marked as true by 5% of the men. As many as 41.3% of the participants believed that early prostate surgery for BPH would prevent prostate cancer, and 13% reported that sexual activity ceases with prostate surgery and that retrograde ejaculation or anejaculation is the end of sexual activity in men. CONCLUSION: The survey clearly showed that prostate awareness is still very unsatisfactory in the Turkish male population and that urologists need to better inform the general population. PD knowledge is still lacking throughout all education levels. This is a unique study showing a cross-sectional analysis of the Turkish community; however, the applicability of these results to other communities should be evaluated.

Use of botulinim toxin-A for the treatment of overactive bladder symptoms in patients with Parkinsons's disease.

AIM: To evaluate the efficacy of intravesical Botulinum toxin injection for overactive bladder symptoms in patients with Parkinson's disease. MATERIALS AND METHOD: Parkinson's Disease patients with overactive bladder symptoms and incontinence were included in the study. Patients were interviewed using the SEAPI questionnaire. The caregivers evaluated their decline in quality of life using the visual analog scale. Intradetrusor injection technique with 30 point template was employed. All patients received 500 i.u. of botulinum toxin-A. The follow-up was at week one and every 12 weeks thereafter for 12 months. Primary caregiver quality of life assessments were also performed using the VAS scale in every visit. RESULTS: Sixteen patients were followed for 12 months. The mean age of the group was 67.2 +/- 5.1. Initial mean functional bladder capacity for the group was 198.6 +/- 33.7 mL.In the third month control the mean bladder capacity increased to 319 +/- 41.1 mL. The quality of life assessment of primary caregiver as well as the patients also statistically improved after the injections (p < 0.05 for both). No neurological detoriation, confusion or disorientation were noted. At the 9th month control 6 patients experienced some urgency which they could suppress and were continent, 4 patients reported occasional incontinence (once in 2-3 days) and 6 patients reported once daily or more incontinence episodes. Medical therapy was prescribed for 12 patients and 4 asked for repeat injections. CONCLUSION: Intravesical botulinum toxin injection is an effective treatment modality with local action and no central nervous system side effects in patients with Parkinson's disease.

An unappreciated correlation : surgical treatment of lumbosacral disc disease and erectile dysfunction.

OBJECTIVE: The aim of the present study was to assess the effect of lumbar disc herniation surgery for low back pain on the erectile functioning. METHODS: Thirty-eight patients, with age ranging from 22 to 56 years, who had presented with pain due to herniated lumbar discs were included in the study. International Index of Erectile Function (IIEF) Short Form questionnaire was used to evaluate the erectile functioning. Patient visits on the 1st week,1st month and 3rd month postoperatively were analyzed. Pain scores were also noted together with side effects and the complications of the surgery. RESULTS: Of the 38 patients, 18 patients had reported erectile dysfunction; 10 patients mild and 8 patients moderate erectile dysfunction. Twenty patients did not report erectile problems. The herniation levels mostly were L5-S1 in 12 (31.6%). Overall, erectile dysfunction rates have improved in 31.7% of those previously with erectile dysfunction in a 3 month period after the surgery. Best results were obtained in those patients with mild erectile dysfunction preoperatively. CONCLUSION: Mild erectile dysfunction together with radiculopathy tends to improve after lumbosacral disc surgery. Moderate and severe erectile dysfunction may be related to a more severe nerve injury or to vascular and/or psychiatric factors. An evaluation of erectile functioning should routinely be performed in patients with lumbosacral disc disease both for data accumulation and for medico legal causes since the documentation of the correlation between erectile dysfunction and lumbosacral disc disease is still lacking.

Combination antioxidant effect of α-tocoferol and erdosteine in ischemia-reperfusion injury in rat model.

INTRODUCTION: Renal ischemia/reperfusion (I/R) which is an important cause of renal dysfunction is inevitable in renal transplantation, surgical revascularization of the renal artery, partial nephrectomy and treatment of suprarenal aortic aneurysms. AIM: The purpose of this study was to investigate the efficacy of α-tocopherol and erdosteine combination in the reduction in injury induced by ROS in a rat model of renal ischemia-reperfusion. MATERIALS AND METHODS: Thirty-six- male Wistar albino rats weighing 200-250 g were utilized for this study. Rats were divided into six groups, and each group was consistent of six rats: (1) sham-operated (control), (2) ischemia group (3) I/R group, (4) I/R/α-tocoferol group (5) I/erdosteine group (6). I/R/α-tocoferol and erdosteine group. Biochemically tissue MDA, XO and SOD activities, light and electron microscopic findings were evaluated. RESULTS: The erdosteine and α-tocoferol significantly reversed the effect of protein oxidation and lipid peroxidation induced by I/R shown by the decreased levels of MDA and XO activities. Both MDA and XO levels were found to be lower in group 6 compared to single agent treatment groups, and this was significantly different. All treatment groups showed increased SOD activity, which accounts for their oxidative properties. The mean Paller score of the combination treatment group (group 6) was lower than all groups except the sham group (3.67 ± 1.2), and this finding was statistically significant (0.05). Our results showed that the antioxidant pretreatment with α-tocopherol and erdosteine combination reduced lipid peroxidation of renal cellular membranes in a model of normothermic renal ischemia-reperfusion in rats. Combination of erdosteine and α-tocopherol has a synergistic effect of protection against oxidative processes. Long-term use of α-tocopherol seems to have a greater effect on the prevention of IR injury. However, further investigations are needed for the clinical applications of our findings.

Testicular size and vascular resistance before and after hydrocelectomy.

OBJECTIVE: We sought to determine whether there is an association between hydroceles and testicular size and vascular resistance. SUBJECTS AND METHODS: Twenty-three patients with a mean age of 42.8 years who had a unilateral idiopathic hydrocele and who underwent unilateral hydrocelectomy were included in the study. Testicular size and resistive (RI) and pulsatility (PI) indexes of the intratesticular arteries on the involved and uninvolved sides were measured before and after the hydrocelectomy. RESULTS: We found statistically significant differences in the testicular volumes between the normal side (mean +/- SD, 15.40 +/-3.41 mL) and the side with the hydrocele (20.67 +/- 4.01 mL) before surgery (p < 0.001) and in the volumes in the side with the hydrocele before (20.67 +/- 4.01 mL) and after (16.20 +/- 2.99 mL) surgery (p < 0.001). No such a difference in volume was seen in the normal side before (15.40 +/- 3.41 mL) and after (15.28 +/- 3.24 mL) surgery (p = 0.200). The mean decrease in volume in the testis with the hydrocele after hydrocelectomy was 21%. There were statistically significant differences of RI and PI values between the normal testis (0.59 +/- 0.07 and 1.02 +/- 0.34, respectively) and the testis with hydrocele (0.79 +/- 0.11 and 1.70 +/- 0.56, respectively) before surgery (p < 0.001). In the testis with the hydrocele, we found a statistically significant decrease in RI and PI values (0.62 +/- 0.05 and 1.00 +/- 0.14, respectively) of intratesticular arteries after surgery (p < 0.001). The mean decreases in RI and PI values after hydrocelectomy were 21% and 36%, respectively. CONCLUSION: There is an association between the development of an idiopathic hydrocele and testicular size and vascular resistance. We believe that the increase in volume and vascular resistance is due to an increase in impedance to venous and lymphatic flow.

Global perspectives and controversies in the epidemiology of male erectile dysfunction.

PURPOSE OF REVIEW: Erectile dysfunction is a neurovascular phenomenon that requires an intact psychological, neural, and vascular component. The advent of Food and Drug Administration approval of sildenafil citrate (Viagra) in 1998 has resulted in increased awareness and a large population of patients seeking treatment. Unfortunately, the estimated number of patients seeking medical therapy still persists at approximately 10%. The predominant reasons suggested here are the complexity of sexuality, taboos, cultural restrictions, lack of satisfactory treatment, and acceptance of the situation as a normal sequence of aging. This perspective discusses the global prevalence and the differences in prevalence on a worldwide basis. RECENT FINDINGS: Recent epidemiologic studies from Spain and Germany have suggested lower rates of erectile dysfunction. This, however, may actually reflect population or cultural differences in the perceptions and attitudes towards the condition. Aging, diabetes, coronary artery disease, and cigarette smoking as epidemiologic factors are reviewed extensively, including some of the controversies with the prevalence rates on a global scale. Chronic renal failure, pelvic surgery, and lifestyle determinants similarly suggest there may be subtle differences, requiring further education from the medical care provider in order to have patient acceptance on a relatively earlier scale. SUMMARY: Erectile dysfunction is a worldwide health issue that affects nearly half the men over the age of 40. As the world population ages, the number of patients affected by this disorder will certainly be increased. With the identification of risk factors, it may be possible to identify patients at risk of erectile dysfunction.

Combination therapy for erectile dysfunction: where we are and what's in the future.

Penile erection occurs in response to visual, olfactory, imaginative, and tactile stimuli initiated within the brain and/or on the periphery. Responses to these stimuli are mediated by efferent autonomic outflow originating in the sacral spinal cord and transmitted by the cavernosal and penile nerves. A number of neurotransmitters can play an integral role in corpus cavernosum smooth muscle relaxation, in part regulating penile erection through increased smooth muscle synthesis of the secondary messengers cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP). In addition to direct-acting agents, there are indirect-acting smooth muscle-relaxing agents. Phosphodiesterase (PDE) inhibitors such as sildenafil act indirectly and require sexual stimulation and endogenous nitric oxide production to activate the cGMP pathway effectively. In contrast, agents such as prostaglandin E(1) (PGE(1)) act directly on the trabecular smooth muscle, binding to specific e-prostanoid receptors and increasing cAMP synthesis. For this reason the direct-acting agents do not require sexual stimulation for efficacy. Combination pharmacotherapy has been used experimentally to treat erectile dysfunction for 25 years, using combinations of cAMP synthesis augmentors, smooth muscle relaxants and PDE inhibitors, and alpha-blockers administered via intracavernosal injection. The present era of oral pharmacotherapy treatment has resulted in significant awareness in the field of sexual dysfunction; however, a single agent may not be ideal to sustain penile rigidity, especially if comorbidities and severity of erectile dysfunction are accounted for. The rationale for and recent reports on combination therapy are presented in this review.

When should quality of life be measured after radical cystectomy?

AIM: In this prospective study our aim was to establish the time it takes cystectomized patients' to adapt to their new health status. MATERIALS AND METHOD: A total of 68 patients, having radical cystectomy for bladder cancer (64 males and 4 females) were enrolled in the study. The mean age of the group was 55.4 +/- 8.0 years (range 38-70 years). Continent urinary diversion was applied to 17 while the rest had incontinent urinary diversions. There was no statistical difference between those who had continent and incontinent diversions in regard to pre-operative stage. All patients were given a Beck's Depression Inventory (BDI), an EORTC-QLQ C-30 Version 2 (European Organization for Research on Treatment of Cancer Quality of Life Questionnaire C-30 Version 2) quality of life measurement scale pre-operatively, and post-operatively 3, 6, 12 and >12 months (every 6 months). Log-rank and Student's t-test was used for statistical analysis of the results. RESULTS: The mean follow-up of the study group was 27.7 +/- 7.3 months (range 12-46 months). Five patients at the first 3rd-month control, seven at the 6th-month control and eight at the 12th-month control did not appear for interview, but their available results were also included in the overall assessment. The mean functional score of the study group, evaluated by QLQ C-30, was 80 +/- 25.4 pre-operatively. There is dramatic decrease at the 3rd-month control (56.9 +/- 25.1; p < 0.01). The overall functional score after 12 months (80 +/- 20) is back to the pre-operative value. The mean symptom score of the group pre-operatively was 29.5 +/- 16.7, which showed similar results at 3 and 6 months post-operatively of 29.8 +/- 16.7 and 30.6 +/- 19.4, respectively (p > 0.05). At the 12th-month and thereafter the symptom scores of the patients decreased significantly in comparison to both the pre-operative and the post-operative 3-6 months (23.4 +/- 13.7 and 21.8 +/- 18.5, respectively; p < 0.01 for all). The self-rating general health status of this group was lowest pre-operatively with a mean of 49.8 +/- 26.5. Interestingly, there was a statistically significant increase in the general health status assessment of the patients even at the early post-operative period of 3 months (61.4 +/- 17.2; p < 0.01). The increase in the well-being of the patients increased linearly until the 12th-month control and stabilized thereafter. There was a 23% pre-operative depression rate, which comes down to 16% at the 12th-month control. The peak depression scores suggesting depression are observed at the 3rd-month controls. There is a gradual decrease in depression score starting from the 6th-month controls and all reach minimum scores after 12 months. Ninety-six percent of the study group showed scores even lower than the pre-operative ones. The mean pre-operative and post-operative 12th-month control scores were 11.5 +/- 7.7, and 8.1 +/- 6.8, respectively (p < 0.01). CONCLUSION: Both psychological and health-related quality of life measures come to baseline values and stabilize after the 12th-month period, suggesting that the time frame for the adaptation of patients is 12 months in patients undergoing radical cystectomy surgery. Therefore, we believe it is better to perform any quality of life assessment as an end-point criterion for comparison of treatment modalities in radical cystectomy patients after 12 months.